<!DOCTYPE html>
<html>
<head>
    <meta http-equiv="Content-Type" content="text/html; charset=UTF-8">
    <meta name="viewport" content="width=device-width, initial-scale=1.0, user-scalable=no">
    <meta name="csrf-token" content="{{ csrf_token() }}">
    <title>老侯代读</title>
    <meta name="description" content=""/>
    <meta name="keywords" content=""/>
    <link rel="stylesheet" href="/css/style.css">
    <link rel="stylesheet" href="/css/iconfont.css">
    <script src="/js/jquery.min.js"></script>
    <script src="/js/js.js"></script>
    <script src="/js/partner.js"></script>
    <script src="/js/public.js"></script>
</head>
<body class="hsbg">
<div class="container">
    <input type="hidden">
    <input type="hidden" name="histate" id="histate" value="0">
    <input type="hidden" name="hitype" id="hitype" value="{{$id}}">
    <input type="hidden" name="hiprice" value="{{$memBalances}}" id="hiprice">
    <div class="form-body">
        <ul class="form-box large form-warning">
            <li class="no-border">
                <a class="check-option" href="/partner/bankcodelist.html">{{$bankName}}<img class="to-right"
                                                                                            src="/images/to-right.png"
                                                                                            alt=""></a>
            </li>
            <li >
                <p class="form-tips"><span id="">本次最多提现<i class="tips">{{$memBalances}}.00</i>元</span></p>
                <p class="form-item">
                    <label for="">金额（元）</label>
                    <input id="txtPrice" name="txtPrice" type="text" placeholder="请输入提现金额">
                </p>
            </li>
            <li>
                <p class="form-tips"><span>请输入{{$mobile}}收到的短信验证码</span></p>
                <input type="hidden" name="txtMobile" id="txtMobile" value="{{$mobilestr}}">
                <p class="form-item check-code form-item-bn">
                    <label for="">验证码</label>
                    <input id="txtMobileCode"  name="txtMobileCode" type="text" placeholder="请输入验证码">
                    <input type="button" name="btnCode" class="form-get-code" id="btnCode" value="获取验证码">
                </p>
            </li>
            <li>
                <p class="form-tips"><span id="">提示：<i class="tips">48</i>小时内到账</span></p>
            </li>
        </ul>
        <div class="form-part receipt">
            <h3 class="form-part-title">请依据以下信息开具发票</h3>
            <ul class="form-warning form-box middle ">
                <li>
                    <p class="form-item form-item-bn form-txt">
                        <label for="">发票抬头：</label>
                        <span class="form-val lg-indent">上海小南瓜生活信息科技有限公司

                        <!-- <input id="txtTitle" name="txtTitle" value=""
                                                                readonly="readonly" class="lg-indent" type="text"
                                                                placeholder="请输入发票抬头信息"> -->


                                                                </span>
                    </p>
                </li>
                <li class="two-item clearfix">
                    <p class="form-item form-item-bn form-txt">
                        <label for="">开票金额：</label>
                        <span id="invoiceprice" class="form-val lg-indent">0元</span>

                    </p>
                    <p class="form-item form-item-bn form-txt">
                        <label for="">开票项目：</label>
                        <span class="form-val lg-indent">服务费</span>
                    </p>
                </li>
                <li style="/*border-top: .8rem solid #f2f2f2; */">
                    <p class="form-item form-item-bn form-txt">
                        <label for="">邮寄地址：</label>
                        <span class="form-val lg-indent">{{$address[1]}}</span>
                    </p>
                </li>
                <li class="">
                    <p class="form-item form-item-bn form-txt">
                        <label for="">收件人：</label>
                        <!--                       <input class="lg-indent" type="text" placeholder="请输入收件人名称（联系电话）">-->
                        <span class="form-val lg-indent">{{$address[0]}}</span>
                    </p>
                </li>
            </ul>
            <ul class="form-warning form-box middle ems-info">
                <li class="sml-h">
                    <p class="form-item form-txt form-item-bn">
                        <label for="">快递</label>
                        <input id="txtExpName" name="txtExpName" class="lg-indent" type="text" placeholder="请输入快递名称">
                    </p>
                </li>
                <li class="sml-h">
                    <p class="form-item form-txt">
                        <label for="">快递单号</label>
                        <input id="txtExpNumber" name="txtExpNumber" class="lg-indent" type="text"
                               placeholder="请输入快递单号">
                    </p>
                </li>
            </ul>
        </div>
        <div class="form-next-step" style="">
            {{--<a id="subed" class=""></a>--}}
            <input type="button" onclick="return checkwithdrawmoneyfrom('a');" class="mbtn mbtn-sure"
                   name="btnwithdrawmoney" id="btnwithdrawmoney" value="确认提现">
        </div>
    </div>

</div>
<div id="withdrawmoneysuccess" class="mask">
    <div class="ask-dialog-box">
        <div id="askDialog" class="ask-dialog remind hid">
            <div class="ask-dialog-con">
                <p class="tip-text">提交成功</p>
                <span class="ask-text">您的提现已提交，请等待审核</span>
            </div>
            <p id="closeDialog" class="ask-btn-box clearfix">
                <a href="/partner/commission.html" class="one-sure">确定</a>
            </p>
        </div>
    </div>
</div>
</body>
</html>